(Circulation. 1999;99:829-835.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Validation of a New Noncontact Catheter System for Electroanatomic Mapping of Left Ventricular Endocardium
From the University of Minnesota, Veterans Affairs Medical Center (C.C.G.), Minneapolis, Minn; St. Paul Heart Clinic (S.W.A.), St. Paul, Minn; and Endocardial Solutions Inc (B.P., J.H., J.B., J.S.), St. Paul, Minn.
Correspondence to Charles C. Gornick, MD, Cardiology 111C VAMC, 1 Veterans Dr, Minneapolis, MN 55417. E-mail gorni002{at}maroon.tc.umn.edu
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Abstract |
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Background—Improvements in cardiac mapping are required to advance our understanding and treatment of arrhythmias. This study validated a new noncontact multielectrode array catheter and accompanying analysis system to provide electroanatomic mapping of the entire left ventricular (LV) endocardium during a single beat.
Methods and Results—A 9F 64-electrode balloon array catheter with an inflated size of 1.8x4.6 cm was used to simultaneously record electrical potentials generated by the heart and locate a standard electrophysiology (EP) catheter within the same chamber. By use of the recorded location of the EP-catheter tip, LV geometry was determined. Array potentials served as inputs to a high-order boundary-element method to produce 3360 potential points on the endocardial surface translatable into electrograms or color-coded activation maps. Three methods of validation were used: (1) driven electrodes in an in vitro tank were located; (2) waveforms generated from the array catheter were compared with catheter contact waveforms in canine LV; and (3) sites of local LV endocardial activation were located and marked with radiofrequency lesions. Tank testing located a driven electrode to within 2.33±0.44 mm. Correlation of timing and morphology of computed versus contact electrograms was 0.966. Radiofrequency lesions marked 17 endocardial pacing sites to within 4.0±3.2 mm.
Conclusions—This new system provides anatomically accurate endocardial isopotential mapping during a single cardiac cycle. The locator component enabled placement of a separate EP catheter to any site within the mapped chamber.
Key Words: mapping • catheter ablation • arrhythmia • ventricles • electrophysiology
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Improvements in catheter-based mapping of cardiac chambers are required to facilitate further advances in our understanding and treatment of arrhythmias. Current techniques using catheters with a limited number of recording electrodes guided by fluoroscopy often do not provide sufficiently rapid and accurate anatomic localization for arrhythmia characterization. Furthermore, catheter-based point mapping fails to provide a global view of chamber activation. Global activation maps may allow a better understanding of the critical elements necessary to initiate and maintain a tachycardia, thus enabling more directed therapy. Recently, noncontact electrodes/probes have demonstrated the feasibility of reconstructing endocardial activation sequences during a single cardiac cycle.1 2
This study validated the use of a noncontact, multielectrode array catheter (EnSite) and analysis system (EnSite 3000 System, Endocardial Solutions Inc) to provide electrophysiological and anatomic mapping of the entire left ventricular (LV) endocardium in a single beat. In vitro tank investigations tested system performance in an idealized environment. In vivo studies in canine LV assessed accuracy of reconstructed electrograms by comparing them with contact electrograms recorded with a standard electrophysiology catheter (EP catheter). Finally, studies in canine LV evaluated system accuracy in locating point activation sources at different endocardial sites. Guiding a standard EP catheter to this activation site uses all aspects of the system: (1) geometry setup phase, (2) reconstruction of potentials on the chamber surface, (3) marking of a site on the isopotential map, and (4) guidance of an EP catheter to the site with the locator system (EnGuide).
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Methods |
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General Considerations
The array catheter is connected through a breakout box that also accommodates up to 32 EP-catheter electrodes (16 bipolar or unipolar recording channels) and 12-lead ECG inputs. Signals are processed in an interface unit. A computer workstation uses interface unit outputs to create electroanatomic maps and display unipolar and bipolar waveforms. A standard EP catheter is "located" by the array catheter and is used to trace the endocardial surface to reconstruct chamber geometry. Chamber geometry, known locations of array electrodes, and noncontact potentials at each electrode on the array are combined to reconstruct potentials from the endocardial surface. Thus, a high-resolution electroanatomic map of even a single beat of either normal or abnormal rhythm can be created.
Technical Considerations
Array Catheter
The 9F array catheter has a central lumen for a 0.035-in
guidewire (Figure 1
). Moving distal to
proximal, the catheter has a pigtail tip, ring electrode, balloon
array, 2 intrachamber ring electrodes, and a fourth proximal system
reference-ring electrode. The array comprises a braid of 64
polyimide-insulated, 0.003-in stainless steel wires over a 7.5-mL
balloon. Electrodes at known locations were made by laser removal of
0.025 inches of insulation. When the balloon is inflated, array size is
1.8x4.6 cm.
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EP-Catheter Location System
EP-catheter-tip location used a low-level, 5.68-kHz current that
was sourced to the distal electrode and returned to each of 2
intrachamber ring electrodes on the array catheter. This high-frequency
signal was sampled and demodulated from each of the 64 array electrodes
at 100 times per second. With use of potentials from each of the array
electrodes, knowledge of their position in 3 dimensions (determined by
design), and knowledge of current sink-electrode positions, the
location of the EP-catheter electrode within the chamber could be
determined. The location method solves a point source-sink model
(accounting for ambient conductivity) using a standard nonlinear least
squares algorithm (Levenberg-Marquardt).
Determination of Chamber Geometry
By use of fluoroscopy and the system's locator, a
standard EP catheter is used to trace the inner surface of the chamber
over a 2-minute sampling period. Sampling of the position of the
catheter tip occurs with each diastole as the operator
moves the catheter to locations throughout the chamber. In animals
studied, average heart rate was 120 bpm, resulting in 
240 location
samples. If adequate sampling was not achieved, geometry acquisition
could be repeated. Sampled locations were put into a convex hull
algorithm with the extrema (eliminating intracavitary points) used to
build a faceted model. The latter was subjected to a smooth spline
curve fit to create the chamber geometry used (contour geometry
acquisition method).
Isopotential Map Generation
Array potentials were sampled at 1200 times per second and
passed to a high-order boundary-element method. The boundary-element
method was used in an inverse formulation to solve Laplace's equation
for each sample to yield endocardial potentials. An optimized
regularization was required to produce accurate results, and a spline
curve fit was used to produce 3360 potential points on the endocardial
surface. Each of these potential points was represented on
the chamber model by vertices of a superimposed grid. Potentials
generated can be translated into electrograms, and maps can be created
with colors used to represent the potentials. Maps are
presented in animation to reveal activation patterns.
In Vitro Studies
Open cell polyurethane foam sections with cutouts to yield a
hollow ellipsoidal chamber 7 cm across by 11 cm long were placed in a
tank 30 cm high by 26 cm across (Figure 2). With the tank filled with 0.45%
saline, the chamber had a conductivity of 0.7 s/m and the surrounding
foam 0.25 s/m. Five electrodes were vertically placed 12 mm apart
on the chamber surface, with return electrodes placed 3 cm deep in the
foam.
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The array catheter was fixed vertically in the chamber. Data were taken at 50, 40, 30, 20, and 10 mm from the array center horizontal to the chamber surface. Because the 5 surface electrodes were not equatorial to the array, the distance from each electrode to the array center varied from 10 to 58 mm. A custom-designed roving electrode consisted of a guidewire surrounded by a nonconducting sheath. At each of the 5 array positions, the roving electrode connected to the locator was used to obtain a representation of chamber geometry.
A low-amplitude, 12-Hz sinusoidal current was applied to each of the 5 surface electrodes, creating a focal potential. Signal amplitudes measured from other surface electrodes 12 and 24 mm away were 0.25 mV and 60 µV root mean square, respectively. The center of this focal potential visible on the isopotential map was marked with available map labels.
Map labels corresponding to grid vertices were generated by the analysis system. The distance between vertices varied from 0.79 mm at 10 mm from the array center to 3.96 mm at 50 mm. There is greater distance between grid vertices as the distance from the array to the chamber surface increases, which is related to arc lengthening.
The roving electrode was directed to the labeled site with the locator and system map and anchored into the foam to mark the site. The foam wedge containing the driven and roving electrodes was removed and the distance between the electrodes measured. The wedge was reinserted and the procedure repeated with each of 5 surface electrode sites at each of 5 array positions.
In Vivo Studies
Animal studies were performed at the Minneapolis, Minn,
Veterans Affairs Medical Center (accredited by the American Association
for Accreditation of Laboratory Animal Care) and were approved by the
institute's Research Subcommittee for Animal Studies.
Sixteen mongrel dogs (weight, 25 kg) were anesthetized with
sodium pentobarbital (18 mg/kg IV). Animals were intubated and
ventilated with a mixture of isoflurane 1% to 2% delivered in oxygen
to maintain anesthesia. In 5 animals, only
arterial catheterization was used to
compare reconstructed endocardial electrograms with contact
electrograms. In the remaining 11, succinyl choline 0.4 mg/kg was used
as a muscle relaxant before thoracotomy. At the conclusion of the
experiment, all animals were euthanized with sodium pentobarbital (80
mg/kg) and sodium phenytoin (10 mg/kg).
In all 16 animals, a 9F introducer was placed
percutaneously in the left femoral artery for
introduction of the array catheter into the LV. An 8F introducer placed
in the right femoral artery was used to introduce a 6F deflectable-tip
EP catheter (4-mm-tip electrode) into the LV. In the 11 animals
undergoing thoracotomy, the right external jugular vein was used for
introduction of a positive fixation pacing lead to the right
ventricular (RV) apex for use as a positional reference.
After thoracotomy, 4 small incisions were made through the pericardium
to place plunge electrodes. Plunge electrodes were constructed with
0.009-in-diameter, polyimide-insulated wire folded and inserted into a
19-gauge needle. The tips (2 mm) of the wire were stripped of
insulation and folded along the shaft of the needle. The needle was
advanced through the myocardium until blood flowed freely,
indicating an intracavitary location. The needle was then withdrawn,
leaving the electrodes hooked on the endocardial surface. A silicone
plug with felt backing placed over the wires was snugly fit to the
epicardial surface to hold the electrodes in place. Each electrode pair
was labeled A through D in a blinded fashion such that only the
technician placing them knew their location. Electrodes were placed in
the anterior and anterolateral LV, with attempts made to avoid the
papillary muscles and to include sites from base to apex (Figure 3). The chest was closed, allowing no
further visualization of the location of the plunge electrodes.
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The array catheter was advanced into the LV with the tip in the apex. The balloon was inflated by use of a saline/x-ray contrast solution. A 6F EP catheter was advanced into the LV, connected to the system locator, and used to trace the contour of the LV. In the 5 animals in which electrogram comparisons were made, the EP-catheter tip was located within the LV chamber by use of the locator function of the system. Unipolar electrograms were recorded from the catheter tip for later comparison with computed electrograms from the same site.
In the 11 animals with plunge electrodes, LV geometry was similarly determined. The RV electrode was identified with the locator to orient septal location. Each of the 4 plunge electrodes was "located" and paced. Pacing threshold determinations (4-ms pulse width) were made at each of the electrodes. At pacing outputs just below capture level, endocardial activation was monitored to ensure the pacing stimulus artifact was not being targeted versus actual pacing-induced ventricular activation. A plunge electrode was randomly selected and paced every fourth beat with a current level 0.1 mA above threshold. This kept hemodynamic consequences at a minimum and limited the size of the pacing stimulus artifact. The analysis system was programmed to display only the paced beats. Using the generated isopotential maps and locator function, we positioned the EP-catheter tip as close to the site of onset of paced ventricular activation as possible. Using a radiofrequency (RF) generator (Radionics RFG-3B) delivering 25 W between the catheter tip and an abdominal ground pad for 2 minutes, we marked the site permanently for later autopsy evaluation. After RF lesion placement, repeat pacing threshold measurements were made. In 5 of 11 animals, a single RF lesion was placed at 1 plunge-electrode site. In the remaining 6, a single RF lesion was placed at each of 2 plunge-electrode sites. RF application frequently resulted in ventricular arrhythmias. Despite their occurrence, stability of the catheter was maintained, as confirmed by fluoroscopy and the locator function. After animals were euthanized, the array and EP catheters were removed. The RV and LV plunge-electrode positions were preserved during cardiac removal at autopsy. The LV was opened along the posterior wall away from the location of the plunge electrodes. The site of RF lesion was documented photographically. RF lesion diameter and distance from both edge and center of lesion to the plunge electrode were measured. Careful attention was paid to the location of any trabeculations, papillary muscles, and Purkinje strands located in relation to the RF lesions or the plunge electrodes.
Data Analysis
In the in vitro studies, the measured distance between the
roving and driven electrodes was compared by 2-way ANOVA (with array
catheter and driven electrode positions serving as the 2 independent
factors) with that obtained with the EnSite System.
In the in vivo studies, electrograms were computed by use of the
boundary-element method at the endocardial surface location of the
located EP-catheter tip, and their timing and morphology were compared
with contact electrograms. Cross correlation was calculated with the
equation:
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Results |
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In Vitro Tank Testing
We assessed locator precision by taking the difference between positions of the driven and roving electrodes on the chamber surface as measured by the locator function. This distance was compared with the physically measured distance. Within a range of <50 mm, the locator function had a precision of -0.33±0.45 mm (negative difference indicates the locator underestimated the distance between the roving and driven electrodes). Within the range of <50 mm, the roving electrode could be guided by use of the locator function to within 2.33±0.44 mm of the focal potential (driven electrode) rendered on the generated isopotential map. The position of the driven electrode on the chamber surface (ie, whether it was equatorial or polar in relation to the array) was not related (P=0.29 by ANOVA) to the ability to locate it. At distances >50 mm from the array to the driven electrode, the precision of the locator was reduced to -0.75±1.13 mm. The ability to locate the focal potential by use of the isopotential map presentation was reduced to a mean of 7.50±1.13 mm (P<0.01 by ANOVA).
In Vivo Comparison of Computed and Contact Electrograms
Timing and morphology of computed electrograms were compared with
contact electrograms from the endocardial surface (Figure 4). Distances of sites from the center of
the array, as measured by the locator, ranged from 9.9 to 48.1 mm
(27.4±9.1 mm). Using correlation timing analysis (see
Equation in Methods section), 567 beats were analyzed from 5
dogs (19 beats at each of 6 ventricular sites per
animal). Timing difference between computed and contact electrograms
was -0.64±2.48 ms (negative value indicates computed activation
onsets were earlier than those measured from the contact electrograms).
Waveform correlations at time shifts corresponding to maximum
morphology match had a mean of 0.966 and a median of 0.984. Most beats
(91%) had a correlation 
0.90.
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In Vivo Studies Locating Site of Endocardial Pacing
Locations of the 17 endocardial pacing sites studied are
depicted in Figure 5. Figure 6 provides graphic representation
of all 17 sites that were paced, mapped, and marked with an RF lesion
regarding their distance and location in reference to the actual
location of the endocardial plunge-electrode site. Note that there are
no systematic directional errors in the location of the RF lesions
placed. Average diameter of the RF lesions was 5.8±1.1 mm.
Distances from the center and edge of the RF lesions to the plunge
electrodes were 4.0±3.2 mm (median, 3 mm) and 1.2±3.2
mm (median, 1 mm), respectively. Figure 7 demonstrates the isopotential
activation maps obtained and subsequent pathological findings after RF
lesion placement in 2 experiments. In 2 animals, plunge electrodes were
in contact with Purkinje fibers (Figure 8). In both, the site of the RF lesion
was at or near the site at which these fibers entered the endocardium.
When the latter are used as the sites of earliest activation, the
distance from the center and edge of the lesion to the
pace-activated site becomes 3.0±2.9 mm (median, 3
mm) and 0.2±2.9 mm (median, 0 mm), respectively. In 11 of 17
lesions, there was an increase in pacing threshold, and there was a
complete loss of capture in 2.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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The EnSite system, which includes the array catheter and computerized mapping system, demonstrated excellent accuracy in locating a driven electrode during in vitro tank testing at distances
50 mm from the array, whereas accuracy at >50 mm was less.
In vivo testing in the canine LV demonstrated the capability of the
system to produce noncontact electrograms that are highly correlated to
contact electrograms in terms of both activation timing and morphology.
Thus, the system was demonstrated to accurately map endocardial
activation of the entire canine LV in a single beat. Finally, using
activation mapping and locator function, we accurately directed an EP
catheter to sites of focal endocardial activation produced by
pacing.
In Vitro Tank Testing
During testing of the mapping system in an idealized
environment, 4 potential causes of error in determining distances
between the roving and driven electrodes were identified: (1)
difficulty in placing the roving electrode, (2) error in the
boundary-element isopotential-map generation such that the resultant
electrical field created by the driven electrode was not accurately
positioned on the endocardial model, (3) granularity due to the finite
number of grid vertices (3360) on which endocardial sites can be
labeled, and (4) error in locator positioning of the roving electrode.
Although there were some minor difficulties in placing the roving
electrode at the desired location, the majority of error identified
related to grid granularity as the distance from the array catheter
exceeded 5 cm. (Distance between grid vertices increases as the radial
distance from the array catheter increases.) This error was compounded
because only grid vertices and not areas between were used to label the
focal potential created by the driven electrode. Corrections, which are
being developed, include supporting map labels everywhere rather than
only at grid vertices.
In Vivo Comparison of Computed and Contact Electrograms
The mapping system was very good at computing electrograms that
closely matched those recorded from the endocardial surface both in
timing and in morphology. Importantly, the electrograms for these
comparisons needed to be accurately located anatomically. Thus, the
accurate reconstruction of electrograms simultaneously
tested both the boundary-element inverse solution as well as locator
functionality (including ability to reconstruct chamber geometry).
In Vivo Studies Locating Site of Endocardial Pacing
Locating point pacing sites on the endocardial surface uses
many of the features of this new technology. Using the locator
function, a separate EP catheter could be placed at these sites with
ease and accuracy. Physical access to sites despite anatomic
obstacles, such as papillary muscles, was supportive of system
accuracy, despite the fact that these obstacles hindered placement of
the EP catheter. There was no systematic error in RF lesion location
with respect to either endocardial pacing site location or position of
the pacing site in reference to the array.
Study Limitations
The in vitro studies used an idealized chamber. In vitro
testing with more complex chamber shapes may be useful in the future.
Although the ability to accurately reconstruct chamber geometry was not
independently validated in our studies, indirect evidence supports the
accuracy of the system. First, the locator system performed well in the
tank environment, and second, the ability to reconstruct electrograms
and locate endocardial pacing sites in the animal studies required
accurate chamber geometry reconstruction. In the animal studies,
electrogram waveform morphology and timing comparisons were performed
during sinus rhythm. Comparisons of electrograms during
ventricular tachycardia were not performed. The
focally paced and activated model used created local activation
in otherwise healthy tissue. Because clinical ventricular
tachycardia often does not involve a focal etiology and
occurs in diseased tissue, the clinical relevance of these studies must
be viewed accordingly.
Comparison of the EnSite System With Other Catheter-Based
Techniques of Electroanatomic Endocardial Mapping
Attempts to accurately map the LV endocardial surface
originated with single catheters used to sequentially map point by
point.3 Anatomic location has been crudely assessed by use
of fluoroscopy. Attempts to increase the number of
simultaneously mapped sites include increasing the number
of electrodes on each catheter, increasing the number of
catheters,4 and creating different catheter
shapes.5 6 None of these techniques allow for rapid and
anatomically accurate mapping of the entire endocardial surface.
Furthermore, the ability to guide an additional EP catheter to a
specific site can be impeded by the presence of other catheters used in
the mapping process.5
Using a special catheter containing a magnetic field sensor along with a magnetic field emitter located beneath the patient table (Carto, Biosense), Gepstein et al7 created anatomically accurate global activation maps. Activation maps were sequentially constructed by use of contact electrograms from the catheter tip. The obvious limitation of this approach is that because the acquired data are not coherent in time, multiple beats are required for creation of the activation map. Thus, a stable rhythm and hemodynamic tolerance are required during map acquisition. Another limitation is the required special catheter containing a magnetic field sensor.
Khoury et al2 reported mapping endocardial activation using a multipolar, olive-shaped, noncontact probe in isolated perfused canine LV. Using a boundary-element inverse solution, they reported good results in locating a paced activation site. However, they noted a 10° rotational error in defining the position of the probe relative to the endocardium, which yielded an 11-mm error in locating the paced site. The reconstructed potentials were noted to be sensitive to errors in geometry and probe position, but the spatial characteristics (locations of maxima and minima) were fairly accurate. Recently, this work was expanded to include an in situ study in a single dog.8 Serial transepicardial echocardiographic images were used to reconstruct LV internal geometry. Accurate chamber reconstruction was demonstrated to be a prerequisite to reconstruct endocardial potentials.
Accurate reconstruction of chamber geometry is required for noncontact mapping. In the system used in the present studies, the same array and EP catheters provided input to both anatomic (locator) and electrophysiological functions, thereby largely eliminating any rotational error. For example, if a 10° rotation were imposed on the array, then a given site would be rendered in a rotated position. Accordingly, a catheter tip viewed with the locator would still be appropriately guided to the now-rotated site. Furthermore, the stability of the array catheter (with the tip seated in the LV apex) contributed to the accurate location of sites in these studies. Finally, the array catheter, by virtue of its noncontact position, allows placement of a separate EP catheter to endocardial sites without significant difficulty.
Conclusions
The EnSite System, which includes the noncontact balloon
multielectrode array catheter and computerized mapping system, provides
anatomically accurate endocardial isopotential mapping during a single
cardiac cycle. Furthermore, the EnGuide locator component allows for
the accurate and expeditious placement of an EP catheter to sites
within the mapped chamber. The creation of global electroanatomic
chamber maps, with animated isopotential and isochronal
presentations, and the ability to capture the activation
pattern of a single beat may advance our understanding and treatment of
human cardiac arrhythmias.
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Acknowledgments |
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Funding for this study was provided by a grant from Endocardial Solutions Inc, administered by the Minnesota Medical Foundation. The authors would like to thank Margaret Fashingbauer, David Marx, Diane Jaimes, and Jan Weigenant for their technical assistance.
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Footnotes |
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B. Pederson, J. Hauck, J. Budd, and J. Schweitzer are employees of Endocardial Solutions Inc, the manufacturer of the device studied in this report.
Received April 2, 1998; revision received September 25, 1998; accepted October 1, 1998.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. Taccardi B, Arisi G, Macchi E, Baruffi S, Spaggiari S. A new intracavitary probe for detecting the site of origin of ectopic ventricular beats during one cardiac cycle. Circulation. 1987;75:272–281.
2.
Khoury D, Taccardi B, Lux R, Ershler P, Rudy Y.
Reconstruction of endocardial potentials and activation sequences from
intracavitary probe measurements: localization of pacing sites and
effects of myocardial structure. Circulation. 1995;91:845–863.
3.
Josephson M, Horowitz L, Farshidi A, Spear J, Kastor
J, Moore E. Recurrent sustained ventricular
tachycardia, II: endocardial mapping.
Circulation. 1978;57:440–447.
4. Davis L, Cooper M, Johnson D, Uther J, Richards D, Ross D. Simultaneous 60-electrode mapping of ventricular tachycardia using percutaneous catheters. J Am Coll Cardiol. 1994;24:709–719.[Abstract]
5.
Eldar M, Fitzpatrick A, Ohad D, Smith MF, Hsu S,
Whayne JG, Vered Z, Rotstein Z, Kordis T, Swanson DK, Chin M, Scheinman
MM, Lesch MD, Greenspon AJ. Percutaneous multielectrode
endocardial mapping during ventricular
tachycardia in the swine model. Circulation. 1996;94:1125–1130.
6. Greenspon A, Hsu S, Datorre S. Successful radiofrequency catheter ablation of sustained ventricular tachycardia postmyocardial infarction in man guided by a multielectrode "basket" catheter. J Cardiovasc Electrophysiol. 1997;8:565–570.[Medline] [Order article via Infotrieve]
7.
Gepstein L, Hayam G, Ben-Haim S. A novel method for
nonfluoroscopic catheter-based electroanatomical mapping of the heart:
in vitro and in vivo accuracy results. Circulation. 1997;95:1611–1622.
8.
Khoury D, Berrier K, Badruddin S, Zoghbi W.
Three-dimensional electrophysiological
imaging of the intact canine left ventricle using a noncontact
multielectrode cavitary probe: study of sinus, paced, and spontaneous
premature beats. Circulation. 1998;97:399–409.This
study validated a noncontact catheter mapping system. The recorded
location of an electrophysiology (EP) catheter determined LV geometry.
Array potentials were input by a boundary-element method to produce
isopotential activation maps. In vitro testing located a driven
electrode to within 2.33±0.44 mm, in vivo correlation of computed
versus contact electrograms was 0.966, and 17 endocardial pacing sites
were located to within 4.0±3.2 mm. This new system provides
anatomically accurate single-beat mapping and guides an EP catheter to
sites within the chamber.
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A. M. Yue, T. R. Betts, P. R. Roberts, and J. M. Morgan Global Dynamic Coupling of Activation and Repolarization in the Human Ventricle Circulation, October 25, 2005; 112(17): 2592 - 2601. [Abstract] [Full Text] [PDF]
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A. M. Yue, M. R. Franz, P. R. Roberts, and J. M. Morgan Global Endocardial Electrical Restitution in Human Right and Left Ventricles Determined by Noncontact Mapping J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1067 - 1075. [Abstract] [Full Text] [PDF]
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T. H. Everett IV, E. E. Wilson, S. Foreman, and J. E. Olgin Mechanisms of Ventricular Fibrillation in Canine Models of Congestive Heart Failure and Ischemia Assessed by In Vivo Noncontact Mapping Circulation, September 13, 2005; 112(11): 1532 - 1541. [Abstract] [Full Text] [PDF]
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A. Thiagalingam, E. M. Wallace, C. R. Campbell, A. C. Boyd, V. E. Eipper, K. Byth, D. L. Ross, and P. Kovoor Value of Noncontact Mapping for Identifying Left Ventricular Scar in an Ovine Model Circulation, November 16, 2004; 110(20): 3175 - 3180. [Abstract] [Full Text] [PDF]
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A. M. Yue, J. R. Paisey, S. Robinson, T. R. Betts, P. R. Roberts, and J. M. Morgan Determination of Human Ventricular Repolarization by Noncontact Mapping: Validation With Monophasic Action Potential Recordings Circulation, September 14, 2004; 110(11): 1343 - 1350. [Abstract] [Full Text] [PDF]
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A. Auricchio, C. Fantoni, F. Regoli, C. Carbucicchio, A. Goette, C. Geller, M. Kloss, and H. Klein Characterization of Left Ventricular Activation in Patients With Heart Failure and Left Bundle-Branch Block Circulation, March 9, 2004; 109(9): 1133 - 1139. [Abstract] [Full Text] [PDF]
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T. Dickfeld, H. Calkins, M. Zviman, R. Kato, G. Meininger, L. Lickfett, R. Berger, H. Halperin, and S. B. Solomon Anatomic Stereotactic Catheter Ablation on Three-Dimensional Magnetic Resonance Images in Real Time Circulation, November 11, 2003; 108(19): 2407 - 2413. [Abstract] [Full Text] [PDF]
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V. Markides, R. J. Schilling, S. Yen Ho, A. W.C. Chow, D. W. Davies, and N. S. Peters Characterization of Left Atrial Activation in the Intact Human Heart Circulation, February 11, 2003; 107(5): 733 - 739. [Abstract] [Full Text] [PDF]
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S. D. Satti and L. M. Epstein Cardiologic Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1253 - 1270. [Full Text]
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 P. A Friedman Novel mapping techniques for cardiac electrophysiology Heart, June 1, 2002; 87(6): 575 - 582. [Full Text] [PDF]
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 P. Della Bella, A. Pappalardo, S. Riva, C. Tondo, G. Fassini, and N. Trevisi Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia Eur. Heart J., May 1, 2002; 23(9): 742 - 752. [Abstract] [Full Text] [PDF]
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G. Hindricks and H. Kottkamp Simultaneous Noncontact Mapping of Left Atrium in Patients With Paroxysmal Atrial Fibrillation Circulation, July 17, 2001; 104(3): 297 - 303. [Abstract] [Full Text] [PDF]
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N Saoudi, F Cosio, A Waldo, S.A Chen, Y Iesaka, M Lesh, S Saksena, J Salerno, and W Schoels A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. A Statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Eur. Heart J., July 2, 2001; 22(14): 1162 - 1182. [PDF]
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T. Paul, B. Windhagen-Mahnert, T. Kriebel, H. Bertram, R. Kaulitz, T. Korte, M. Niehaus, and J. Tebbenjohanns Atrial Reentrant Tachycardia After Surgery for Congenital Heart Disease : Endocardial Mapping and Radiofrequency Catheter Ablation Using a Novel, Noncontact Mapping System Circulation, May 8, 2001; 103(18): 2266 - 2271. [Abstract] [Full Text] [PDF]
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 G. L. Pierpont, S. S. Chugh, J. A. Hauck, and C. C. Gornick Endocardial activation during ventricular fibrillation in normal and failing canine hearts Am J Physiol Heart Circ Physiol, October 1, 2000; 279(4): H1737 - H1747. [Abstract] [Full Text] [PDF]
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S. A. Strickberger, B. P. Knight, G. F. Michaud, F. Pelosi, and F. Morady Mapping and ablation of ventricular tachycardia guided by virtual electrograms using a noncontact, computerized mapping system J. Am. Coll. Cardiol., February 1, 2000; 35(2): 414 - 421. [Abstract] [Full Text] [PDF]
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